Healthier: Fifty Thoughts on the Foundations of Population Health By Sandro Galea
New York, NY: Oxford University Press; 2017 288 pages; $29.95 ISBN-13: 978-0190662417
Dynamic external forces are driving an evolutionary shift in public health in the United States. This reflection and tension are leading to important innovations but, at times, also angst about the value of the profession. This shift is calling into question some of the most fundamental aspects of the field, including our approach to education, the structure and function of public health practice, and the unique skills and capabilities of public health professionals.
Despite the historic importance of public health as a core part of the infrastructure of the United States, the financial, organizational, philosophical, and epidemiological challenges of the past decade have been difficult. The Great Recession caused public health departments across the United States to shrink in size and scope. The Affordable Care Act expanded health insurance coverage, which meant that newly insured individuals did not need to rely on public health clinics, thus changing the workforce needs and role of public health in the community. Technology and advancements in analytics are driving change in public health, as they are in all sectors, and altering expectations about speed of action, use of big data, and need for traditional approaches to surveillance.
RECONFIGURING PUBLIC HEALTH
Perhaps the most significant external force is changing epidemiology of morbidity and mortality in the United States. Life expectancy for the US population declined in 2015 and 2016.1 The underlying cause of this mortality is “social” disease, not communicable disease or even chronic disease. Analysis of the underlying causes points to poisonings such as from opioids and alcohol and to suicide.2,3 Although addressing the social determinants of health has been a historic approach for public health, the competencies and capabilities have atrophied over time.
These changes have caused the field to revisit our approaches to improving the public’s health.4 As a field, public health workers are embracing efforts that have a broad effect in ways that no other parts of the health sector can through policy-, systems-, and environmental-level changes.5,6 The public health schools and training programs are questioning their approach to building the public health workforce and next generation of leaders. The importance of reconfiguring public health research, work, and workforce to address the social determinants of health will only continue to be a rising priority.
FOUNDATIONS OF PUBLIC HEALTH AND SOCIETY
In the midst of this intense reflection and innovation in the public health field, Sandro Galea has written a series of essays in his new book that inform and inspire our thinking about the role of public health today and into the future. The book has five sections:
The Foundations of Population Health
The World as It Is
On Inequities and the Health of Marginalized Populations
The Challenges Faced by Pubic Health
Toward a Healthier World
Each section contains a set of short essays that cover topical areas pertinent to the overarching section. These relatively brief essays are packed with data, philosophy, relevant examples, and reference lists that I found myself compelled to explore.
The book essentially covers Galea’s thoughts on the foundations of public health and reminds us that public health is about more than competencies and science. The ethical, philosophical, and scientific questions he raises in various essays are relevant to any health professional, not only public health professionals. The essays could serve as the foundational component to elective coursework for medicine, law, social work, political science, and business. This is the case because in his essays, Galea is challenging the reader to think about major social, scientific, and health issues that are relevant to many professions and likely will require cross-sector collaboration for optimal resolution. It is a reminder that public health, serving as a chief health strategist, must marshal the talents and capabilities of other sectors to ensure that we have a healthy population and the resultant vital, resilient, just, and economically thriving society.
I can particularly envision this book being the foundation for a seminar series at any level of training. What is especially helpful is that all the essays stand on their own, making it possible to pull relevant chapters to launch discussion in a focused course or workshop. For example, his “Who Should We Talk to, and How?” and “On Engaging the Media” chapters stand alone and would be relevant for a public health communications course.
TRAINING OUR FUTURE WORKFORCE AND LEADERSHIP
This book is more than an academic resource; it is a conversation starter and a bridge to our peers in other sectors. Just as Galea has done in past writing and his professional life, he does not shy away from controversial topics or opinions. His essays challenge the public health community and partners to think deeply about our responsibilities, approach, and legacy. This book is useful across the educational continuum, but I believe that many faculty and experienced public health professionals would find it valuable to stimulate thinking about the field. This book is also a valuable touchstone for public health leaders and thus would be useful as required reading or as a resource for training new leadership in public health practice and academics or policy.7
Galea’s book left me optimistic and inspired about the public health profession in this tumultuous time. I was reminded about our strong history in solving complex health challenges that have had a major effect on the trajectory of life, quality of life, and vitality. Public health brings not only a unique set of professional skills, experiences, and capabilities but also humility, humanity, and a sense of duty to every person and every community. My optimism is tempered with the realization that future success requires us to step up, advance, and evolve public health training, science, and practice to meet the epidemiological challenges of our day. Galea’s book provides provoking nudges to encourage public health professionals and our partners to move thoughtfully, although with urgency, to heed the call to leadership to create the conditions in which everyone can be healthy.
REFERENCES
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